Placing Dogs in the Lap of Luxury

Owner Information

Name

Contact Phone Number

Email Address

Location

Dog Information

Dog's Name

Sex (male or female)

Is Dog Spayed/Neutere?

Breed

Weight

Approximate age or birthdate

Where did you get the dog?

How long have you owned the dog? Have they had previous owners

Where does the dog sleep at night?

Where do you keep the dog when you have to leave the house?

Loose in the house
Restricted to one or two rooms
In a cage or crate indoors
Loose outdoors
Tethered outdoors
In a kennel outdoors

Is the dog housebroken?

Is the dog crate trained?

Is the dog destructive when left alone?

When left alone does the dog:

Bark
Chew furniture
Chew personal items (shoes, clothes etc)
Scratch and dig doors and windowsills
Pee or poop in the house
None of the above

When allowed outside the dog was:

Chained in yard
Loose
In fenced yard
In kennel

When allowed outside unsupervised did the dog:

Dig holes
Escape frequently
Bark continuously
Bark at strangers
Bark at other animals
Seems content

Has the dog been consistently around children? If yes, please list ages of children:

Is the dog too rough when playing with kids, or does it play politely?

Have the dog’s experiences with children always been positive? (please explain)

Has this dog ever lived with cats? Does it like cats? Has the dog ever hurt a cat?

Does it get along with other dogs?

Always
Usually
Sometimes
Never

Is the dog from a single dog household? If no, please list the ages, sexes, and sizes of the other dogs

Has the dog ever been allowed to play with other dogs?

Has it ever been in a dog fight in which either dog was injured? If yes, explain

How does your dog react when:

When new visitors enter the house?

You take away it’s favorite toy or bone?

Its disturbed when sleeping in its favorite spot?

You take away its food?

Would you say that most of the time the dog is: (check all that apply)

Friendly
Playful
Shy
Withdrawn
Protective
Affectionate
Hyper
Active
Aggressive
Stubborn
Noisy
Quiet
Destructive

What type of people does the dog feel most comfortable with?

Children
Teenagers
Men
Women
Elderly

Is the dog afraid of:

Visitors
Loud noises
Thunder
Being alone
Vacuum cleaner
Kids
Men
Going to the vet
Other
No fears I am aware of

Will the dog let you:

Groom it

Yes
No

Bathe it

Yes
No

Clip it's nails

Yes
No

If no to any of the above please explain

What, if any, behavioral problems does the dog have?

Has the dog ever bitten a person for any reason?(Please know that this question does not necessarily determine the outcome of the dog.) If yes, please describe the circumstances:

What are two things you like most about the dog’s behavior?

What are two things you don’t like about the dog’s behavior?

Why are you surrendering this pet? (Please give detailed explanation of why)

What would have to happen for you to keep this dog?

Any additional comments or information:

Medical and Vetting Information:

Who is your dog's vet?

Does your dog have any medical problems? If so, please describe.

What health conditions has your dog experienced in the past?

Is it on any medications? If so, please describe.

When was your dog’s last vaccination? Rabies?

*A voluntary contribution towards the future care of your dog is always appreciated and can be accepted at time of surrender or e-transferred to misfitmanordogrescue@gmail.com

It is often helpful if you can email a picture of the dog to us at misfitmanordogrescue@gmail.com